Title : A waiting game: The risky business of repairing a friable septum
Abstract:
This presentation will focus on the critical and complex decision-making process involved in managing ventricular septal defects (VSDs) that develop after myocardial infarction (MI). Although VSDs following MI are rare, they represent a life-threatening complication with a high mortality rate. The presentation will delve into the challenges surrounding the timing of intervention, particularly the debate between early versus delayed closure of the defect, whether through surgical or percutaneous methods.
The case of an 83-year-old female patient will serve as the focal point to illustrate these complexities. The patient presented with chest pain, dizziness, and diaphoresis, later diagnosed with an inferior ST-segment elevation myocardial infarction (STEMI). During emergency cardiac catheterization, a VSD was identified, and initial attempts at percutaneous closure were unsuccessful due to tissue fragility, leading to complications and, ultimately, the patient’s death. In the discussion, the presentation will explore the risks and benefits associated with both early and delayed intervention for post-MI VSD repair. Current guidelines from the American College of Cardiology and American Heart Association recommend early surgery, yet the timing remains controversial, especially in patients who are hemodynamically stable. Delaying surgery may allow for tissue healing and make the repair more feasible, but the risk of sudden hemodynamic compromise poses a significant concern. This case highlights the need for more individualized guidelines that take into account patient-specific factors such as myocardial tissue characteristics and overall clinical stability. It also raises important questions about whether the current recommended waiting periods for surgical repair are adequate in all patients. The presentation will conclude with a discussion on the broader implications of this case for clinical practice, emphasizing the need for ongoing research and revised guidelines to optimize outcomes in patients with post-MI VSD.
